Unoperated Stomach Research Articles

Gastritis cystica polyposa in an unoperated stomach, a case report

Gastritis cystica polyposis (GCP) is a rare benign hyperplastic polypoid neoplasm that usually occurs on the gastric side of anastomoses in patients who have previously undergone gastroenterostomy surgery. Only few cases of GCP have been reported in a previously unoperated stomach. Here we present a 73-year-old female who on investigation for altered bowel habits was found to have a gastric polyp diagnosed as GCP. Both endoscopic and radiological findings are non-specific, and diagnosis depends on histopathological evaluation of the lesion. Histologically the lesion showed a hyperplastic polyp with cystically dilated foveolar and glandular epithelium extending into the submucosa surrounded by disorganised bundles of smooth muscle and without any evidence of cytologic atypia, typical of GCP. Although benign, an associated with gastric carcinoma has been described.

Gastritis Cystica Polyposa Presenting as Multiple Polypoid Lesions in an Unoperated Stomach: Complexity in the Management of a Rare Case

Gastritis Cystica Polyposa Presenting as Multiple Polypoid Lesions in an Unoperated Stomach: Complexity in the Management of a Rare Case

Gastric Adenocarcinoma Associated with Gastritis Cystica Profunda in an Unoperated Stomach

Gastric Adenocarcinoma Associated with Gastritis Cystica Profunda in an Unoperated Stomach

A Ten-year Follow-up of a Case with Gastric Adenoma Accompanied with Gastritis Cystica Profunda Treated by Endoscopic Submucosal Dissection

Gastritis cystica profunda (GCP) is an uncommon hyperplastic benign lesion, and histologically characterized by hyperplasia and cystic dilatation of the gastric glands extending into the submucosal layer. GCP usually occurs at a gastroenterostomy site, although it can occasionally be found in an unoperated stomach. GCP is thought to be a possible precancerous lesion, since a few early gastric cancers associated with it were reported. Herein, we report a case of gastric adenoma associated with GCP in an unoperated patient. The sizes of both the GCP and adenoma overlying it have increased during a 10 year follow-up period. Adenoma on the latest biopsy showed low grade dysplasia, and it was successfully treated by endoscopic submucosal dissection.

Localization of Cytochrome P4502E1 Enzyme in Normal and Cancerous Gastric Mucosa and Association with Its Genetic Polymorphism in Unoperated and Remnant Stomach

Exposure to nitroso compounds and the activity of cytochrome P450 2E1 (CYP2E1), an activation enzyme for these carcinogens, are important factors in gastric carcinogenesis. Here, we investigated the potential correlation between genetic variation in CYP2E1 and its enzyme expression as detected with immunohistochemical (IHC) staining and cancer susceptibility in unoperated and remnant stomach. Expression of CYP2E1 in the stomach (n=117) was detected with IHC staining using a polyclonal anti-CYP2E1 antibody. Interindividual variation in CYP2E1 enzyme activity was then compared with genetic polymorphisms in the transcriptional flanking region of the CYP2E1 gene by restriction fragment length polymorphism (RFLP) detection using the Rsa I restriction enzyme. Genetic polymorphisms of Rsa I RFLP in CYP2E1 were investigated in 499 patients with gastric cancer (466 unoperated stomachs and 33 remnant stomachs) and 553 control patients with benign gastroduodenal diseases. Mucosal IHC staining for CYP2E1 was stronger in areas of intestinal metaplasia, particularly in endocrine cells, which stained consistently and strongly. Expression of CYP2E1 enzyme in areas of IHC staining were confirmed with Western blot analysis and showed a significant association between the degree of staining and the CYP2E1 genotype (p<0.01) in cancer tissues and in the foveolar epithelium of normal gastric mucosa. No association between specific CYP2E1 genotype and gastric cancer risk in the unoperated stomach was found in either the large study or the age- and gender-matched case-control study. However, the frequency of rare alleles (C1/C2 or C2/C2) was significantly higher in patients with cancer in the remnant stomach following gastrectomy than in controls subjects without cancer (odds ratio=2.8, 95% confidence interval=1.3-5.8) or those with primary gastric cancer (odds ratio=2.6, 95% confidence interval=1.3-5.5). CYP2E1 genetic polymorphisms might correlate with CYP2E1 enzyme expression levels in normal and cancerous gastric tissues. These polymorphisms do not influence the development of primary stomach cancer but may do so in specific conditions, such as the remnant stomach after gastrectomy.

Upper GI Bleed Caused by Gastritis Cystica Profunda in an Unoperated Stomach

Upper GI Bleed Caused by Gastritis Cystica Profunda in an Unoperated Stomach

Early gastric cancer associated with gastritis cystica polyposa in the unoperated stomach treated by endoscopic submucosal dissection

Early gastric cancer associated with gastritis cystica polyposa in the unoperated stomach treated by endoscopic submucosal dissection

Gastritis Cystica Polyposa Concomitant with Gastric Inflammatory Fibroid Polyp Occurring in an Unoperated Stomach

The endoscopic examination of a 61-year-old male patient revealed a protruding lesion in the greater curvature of the lower third area of the stomach. The lesion, 17 mm in size, was resected completely with endoscopic submucosal dissection using an insulated-tip diathermic knife (IT-ESD). Histological examination of the protruding lesion revealed proliferation of fibroblasts and infiltration of inflammatory cells in the mucosa and submucosa, and it was diagnosed as an inflammatory fibroid polyp (IFP). Gastritis cystica polyposa (GCP) was presented adjacent to the IFP. This may be the first report of GCP concomitant with gastric IFP occurring in an unoperated stomach.

Diagnostic value of culture, histology and PCR for Helicobacter pylori in the remnant stomach after surgery

Diagnosis of Helicobacter pylori infection in the remnant stomach has not been established. To investigate the diagnostic value of culture, histology, PCR and serum IgG against H. pylori (ELISA) with and without eradication therapy in the remnant stomach, compared with the unoperated stomach. Biopsy samples for bacterial culture and histological diagnosis of H. pylori were taken from the stoma and upper corpus of the remnant stomach and gastric juice was used for PCR assay. Bacterial culture-based diagnosis in the remnant stomach, sensitivity and specificity of culture were 95.1%, 100%; histology 89%, 92.3%; PCR 66%, 89.7%; and ELISA 100%, 50%, respectively, in cases without H. pylori eradication therapy. In assessment of the results of therapy for the remnant stomach, sensitivity and specificity of culture were 100%, 100%; histology 80%, 96.8%; PCR 80%, 91.7%; and ELISA 100%, 0%, respectively. Bacterial culture had the highest diagnostic value in the remnant stomach as well as unoperated stomach. Sensitivity by histology and PCR was lower in the remnant stomach than the unoperated stomach, but specificity values were equal. Serum ELISA assay was not suitable for the remnant stomach.

Endoscopic treatment of gastritis cystica polyposa found in an unoperated stomach

Gastritis cystica polyposa (GCP), characterized by polypoid hyperplasia of the gastric mucosa, is an uncommon lesion that develops in patients who have undergone gastroenterostomy with or without gastric resection.1,2 Endoscopically and radiologically GCP appears as a polypoid mass that is almost always on the gastric side of the anastomosis. This lesion is rarely found in an unoperated stomach.1,3,4 Because it is difficult to differentiate GCP from cancer both radiologically and endoscopically, surgery is required in most cases for diagnosis.

A case of gastritis cystica polyposa showing a characteristic endoscopic ultrasonogram

Littler reported on the torose polypoid lesion observed at the site of gastroenterostomy long after gastrectomy and called it gastritis cystica polyposa (GCP). Since then, much attention has been paid to hypertrophic lesions at the sites of gastroenterostomy, and many reports on GCP have been published. This lesion often develops in patients who had gastroenteroanastomosis. It was observed by the authors that a submucosal tumor developed at the cardiac part of the stomach in a patient who had no history of gastrectomy. Very few cases of GCP were observed in unoperated stomachs. The tumor was excised by endoscopic mucosal resection and diagnosed histopathologically as GCP. Endoscopic ultrasonography before the operation revealed the presence of a spongy body filled with anechoic areas of various sizes under the mucosa of the tumor. This finding is characteristic of this disorder and is detailed here with a discussion on related papers.

Levels of nitrite, nitrate, N-nitroso compounds, ascorbic acid and total bile acids in gastric juice of patients with and without precancerous conditions of the stomach

To determine the relevance of gastric juice factors to gastric carcinogenesis, 56 patients with unoperated stomachs undergoing endoscopy for dyspepsia had gastric juice aspirated and analysed for pH, ascorbic acid, total bile acids, nitrite, nitrate and total nitroso compounds (NOCs). Plasma was obtained for vitamin C estimation. Antral and body biopsies were assessed for gastritis, Helicobacter pylori, atrophy and intestinal metaplasia (IM). Patients with chronic atrophic gastritis (n = 17) had lower gastric juice ascorbic acid concentrations (P less than 0.001), higher pH (P less than 0.05) and higher incidence of H. pylori infection (P less than 0.001) than normal subjects (n = 12). Patients with reflux gastritis (n = 9) had higher total bile acids (P less than 0.01). Patients with chronic gastritis and IM (n = 11) had higher gastric juice pH (P less than 0.01) and total bile acid concentrations (P less than 0.05), and lower gastric ascorbic acid concentrations (P less than 0.01) than those with chronic gastritis and no IM (n = 24). In chronic gastritis, high nitrite concentrations were associated with high pH (P less than 0.01). However, there were no significant differences in plasma vitamin C or gastric nitrite, nitrate or total NOC concentrations in relation to gastric histology. We conclude that the premalignant condition IM is associated with H. pylori infection, low gastric ascorbic acid levels and elevated total bile acids, but not to elevation in nitrite or total NOCs in fasting gastric juice.

Relationship of Campylobacter pylori and duodenogastric reflux.

We have examined the relationship of Campylobacter-like organism (CLO) and duodenogastric reflux (DGR) in 107 patients with unoperated stomachs. Neither the extent of externally measured bile reflux nor the concentrations of bile acids or lysolecithin in the gastric fluid differed significantly in the groups with different numbers of CLO in the gastric mucosa. Our results suggest that DGR, in the quantities commonly present in unoperated stomachs, does not effect the presence of C. pylori in the gastric mucosa.

Pathological features and mucin histochemistry of primary gastric stump carcinoma associated with gastritis cystica polyposa. A study of six cases.

Six unusual cases of primary gastric stump carcinoma associated with gastritis cystica polyposa and arising in old gastrojejunostomy stomas are presented. The clinical data, the gross and microscopic pathological features, and the histochemical mucin profile of these two lesions are described in detail. A review is undertaken of the most relevant and previously published reports concerning, separately, either primary gastric stump carcinoma or gastritis cystica polyposa. The findings available in these reports are compared with those observed in our six cases. Some aspects of gastritis cystica polyposa are not unlike those seen in the solitary ulcer syndrome of the rectum and Ménétrier's disease. The histological type and mucin profile of primary gastric stump carcinoma parallel those recorded in gastric cancer arising in the unoperated stomach. However, the role of intestinal metaplasia and its histochemical typing appear somewhat different in primary gastric stump carcinoma.

The effect of surgery and posture on the pattern and rate of gastric emptying.

A method is described for measuring gastric emptying in the erect and supine positions using a scintiscanner and a radioactive meal. The pattern of emptying after surgery is irregular. Emptying rates up to ten times the normal were recorded after fluid meals with the patient in the erect posture following the various types of operation studied. The mean rale of emptying after Billroth II and vagotomy and pyloroplasty operations exceeded that following Billroth I operations. After the last‐mentioned procedures it did not significantly differ from normal. Whenever rapid emptying of fluids occurred, it was dependent on posture and was markedly slowed if the patient was in the supine position. After solid meals, gastric emptying in the erect position was more rapid than in the supine in the unoperated stomach and also after vagotomy and drainage. However, there was no augmentation of the postural effect by surgery.